Thursday, June 11. 2009

“Once a person has been announced as an expert, they lose the impetus to use wisdom wisely... The problem with being an expert is that once it's been announced you know it all, it almost ceases to matter what you say - because you're an expert. Some perfectly sane, intelligent people fail to question the questionable, because if a statement is prefixed with "the expert's view is ..." they think it escapes analysis... These people don't let new knowledge in, they don't allow for variables, they don't listen. They don't need to, after all. I wonder at which point experts decide they no longer need to learn, because they already know it all?” Annalisa Barbieri, The Guardian, Saturday February 9, 2008

It is time that medicine and involved politicians valued the solid values of Philippians ;-"Whatsoever things are true, whatsoever things are honest, whatsoever things are just, whatsoever things are pure, whatsoever things are lovely, whatsoever things are of good report; if there be any virtue and if there be any praise, think on these things."

Yesterday (10th June 2009), I received an email which was both surprising and unusual. Although Professor Malcolm Lader said in a radio interview in 1991, "The Medical profession, I think, is fairly ashamed of what has happened...” and Professor CH Ashton said in 2005, “How the dependence potential of the benzodiazepines was overlooked by doctors... is a matter for amazement and casts shame on the medical profession...” in my estimation, there has been little sign of it until I received the email that is. A senior GP was reported as saying:

"Do you know I stopped prescribing benzos when you came to us and I saw the mess you were in? I only wish you could be sitting in the corner when I get patients from elsewhere begging me for repeat prescriptions. If they could see what benzos do to people, they perhaps wouldn't be so keen."

This is truth and this is reality but the doctors’ trade union the British Medical Association has never been so frank and maintains the line of it being difficult to change prescribing habits. This may be true and it says a lot about the skill level of prescribers and how seriously patient safety is taken in this country.

Not only has the medical profession as a group failed to display any public sense of shame for what it has done to patients through gross over-prescribing of tranquillisers, but neither have those supposedly in charge of medical provision, the Medicines and Healthcare products Regulatory Authority, The Department of Health and local health authorities. Patients whose lives have been ruined have been left to pick up what pieces they can. Instead, maintaining the image of the NHS as a caring and scientifically based organisation has been the priority for all groups of providers.

Instead of offering help to people who have seriously injured lives, the past has been modified in terms of the present. BMA spokesmen will now say they things like this:

Tranquillisers are very good in the short term. But the problem is people want to go on and on and there’s the problem. Tranquillisers are excellent but they’re not designed for long term use. A lot of people can get off them but I’m afraid there’s a significant minority who have problems. Government should come out so that the public at large know it’s not their right to receive tranquilliser prescriptions. It’s not in their interests. It’s like smoking, alcohol and other things which are bad for people and doctors speak out against. And there is a growing problem of the drugs being obtained from the internet.

The BMA, the Royal College of General Practitioners and the Department of Health not so long ago, used to say things like this:

"There's still a significant continuing problem with benzodiazepines in this country. We would have liked if it was solved 20 years ago, but it still exists. We continue to work as a College with prescribing groups around the country to try and continue to raise awareness of this issue and reduce the prescribing of these drugs to appropriate use, but it is a very long struggle. ...” Dr Jim Kennedy, Royal College of General Practitioners, The Tranquilliser Trap, BBC Panorama, May 13, 2001.

"It is difficult to defend that we have such a huge problem of benzodiazepine prescription and long-term use and therefore dependence. – Professor Louis Appleby, National Director for Mental Health, The Tranquilliser Trap, BBC Panorama, May 13, 2001.

Today all three bodies emphasise internet buying and the role of the patient in insisting on prescriptions. People do buy drugs on the internet and patients do misguidedly ask for inappropriate prescriptions but that does not represent the true history of benzodiazepines in this country. The real history is one of pharmaceutical company marketing influence, the unquestioning attitude of prescribers, the political calculations of government and the ruination of large numbers of patients who thought they were taking medicine through informed advice.

Although benzodiazepines have been over-prescribed in the hundreds of millions to patients for fifty years, no attention has been paid to the real consequences for what the BMA describes as a ‘significant minority’. The BMA has no idea of the size of this ‘minority’, since no provider of medicine has ever thought it worthwhile to find out. The Public Health Minister Dawn Primarolo, who in the 1990s knew that medicine was involved in a scandal, felt no compunction in standing up in Parliament as a government minister recently to declare that the Department of Health had no information on impairment caused by benzodiazepines or the number of addicted patients.

For years a succession of ministers has been using this response:

“First of all let me say that the Department of Health, the NHS and the various professional groups regard involuntary addiction upon benzodiazepine drugs as a very important issue... As you know, the main focus of the Department of Health's action in this area has been to try and prevent addiction/dependence occurring in the first place by warning GPs and other prescribers of the potential side-effects of prescribed medicines and the dangers of involuntary addiction.”Rosie Winterton MP, Minister of State, Department of Health, January 11, 2004

How it is possible to claim that benzodiazepines are an important issue for government when the bones of the issue are denied and ignored in practice, is mystifying. The issue is that government and its regulatory agencies took far too long to believe in the addiction and when they finally did, they did nothing for the thousands already adversely affected and did nothing effective to safeguard those in the future.

Today, five years after Rosie Winterton’s response, a very telling change has taken place within the DoH, There is a stubborn refusal to continue to admit what was admitted in the past. In the past there was admission that medicine had caused a problem, even though the nature of that problem and its size were not explored. Today, if you write to the department, they will not move from a position where the patient is seen as the cause of his own injuries. There has been a change to viewing the patient in the same way as the drug abuser on the street. You have to wonder why this is and it should serve as a warning to those who may in the future take potentially addictive drugs on the advice of doctors. The fact that benzodiazepines on the street are the same as benzodiazepines in the surgery is a poor excuse for maintaining now that if only patients had only been sensible and controlled their drug-seeking behaviour, the consequences would have been avoided. As Shakespeare said, ‘Though this be madness, yet there is method in ‘t.’